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Speaker: Consider all information for diagnosis, treatment of paediatric osteoarticular infections
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PRAGUE — To fully understand the current scientific evidence in the diagnosis and treatment of paediatric osteoarticular infections, it is important to consider all opinions, published studies and randomised controlled trials, according to a presenter here at the 16th EFORT Congress.
“I think that when we start evaluating evidence, it is not about throwing away everything, but just understanding where we are in space so you don’t get lost,” said Markus Pääkkӧnen, MD, of Turku University Hospital in Tampere, Finland.
Pääkkӧnen said the measurement of C-reactive protein is sensitive for the diagnosis of paediatric osteoarticular infections and sequential C-reactive protein (CRP) measurements are useful as markers in follow-up. Measurements of erythrocyte sxedimentation rates (ESR) and CRP levels are also sensitive in the diagnosis of acute paediatric osteoarticular infections, he said. However, fast response to treatment makes for the best sensitivity when one combines CRP and ESR. Measurement of CRP levels is superior in monitoring and is more useful than ESR as a marker during follow-up, he said.
Markus Pääkkӧnen
The measurement of procalcitonin levels for the diagnosis of paediatric osteoarticular infections may equal C-reactive protein, however, it is more expensive, Pääkkӧnen said. Kingella kingae may cause a weak inflammatory response and may not be as reliable as other causative agents. White blood cell count should not be used to rule out an osteoarticular infection, he said. During follow-up, CRP measurements react faster and are superior compared with ESR, he said.
Pääkkӧnen said short-term treatments have not yet been tested for MRSA, Kingella and Salmonella of osteoarticular infections in neonates or children with underlying diseases. He said first-generation cephalosporins and clindamycin are valid treatments for methicillin-sensitive Staphylococcus aureus, pneumococcal or streptococcal paediatric osteoarticular infections. Pääkkӧnen said 2 days to 4 days of intravenous treatment for a total of 3 weeks is sufficient in the treatment of osteomyelitis and 2 weeks of Staphylococcus aureus. Pääkkӧnen said a strong recommendation and a high level of evidence exists for 3 weeks of antibiotic therapy in uncomplicated acute osteomyelitis and 2 weeks for septic arthritis. Individualised therapy is recommended for children who have MRSA, Salmonella, neonates and patients with immunodeficiency, he said.
The use of vancomycin in the treatment of paediatric osteoarticular infections brings concerns about poor bone penetration, he said. There is also high recurrence rates when it is used as monotherapy. Additionally, limited data exist on combining vancomycin with other antibiotics in children, however, it is among a few choices for clindamycin-resistant MRSA.
Reference:
Pääkkӧnen M. Diagnosis and antibiotherapy in acute paediatric osteoarticular infections: What is the current scientific evidence? Presented May 27 at: The 16th EFORT Congress; May 27-29 2015; Prague.
Disclosure: Pääkkӧnen reports no relevant financial disclosures.